• Journal of Korean Neurosurgical Society
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• 제38권3호
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• pp.184-189
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• 2005

Objective : Hemangioblastomas are highly vascular and benign neoplasm of the central nervous system[CNS]. They can often be found as multiple lesions, as is commonly observed in von Hippel-Lindau[VHL] disease. The aim of this study is to determine the proper management for multiple hemangioblastomas. Methods : Since 1990, 78cases of hemangioblastoma have been encountered. Among these, 9cases were multiple hemangioblastomas that were treated with surgical resection with or without radiosurgery. The medical, radiological, surgical and histological records were reviewed retrospectively and analyzed statistically. Results : Nine patients presented with multiple hemangioblastomas and were diagnosed as VHL disease. The mean follow-up duration was 75.7months [$6.6{\sim}159.2months$] after the first surgical treatment. Three patients were treated with surgical resection alone and six patients were treated by both surgical resection and radiosurgery. Twenty-one surgical procedures [13 surgical resections and 8 radiosurgery] were performed. One patient required ventriculoperitoneal shunt and a posterior fossa decompressive craniectomy because of post-radiation brain swelling. Another patient refused additional treatment for the newly developed lesions after the successful treatment of initial lesions. The other patient who presented with numerous lesions in the whole brain and spine underwent cranio-spinal irradiation. Remaining patients showed good results. Conclusion : The surgical outcomes for the patients with a single lesion of the CNS hemangioblastoma are favorable. However. the treatment of multiple hemangioblastoma is more difficult, and should be treated by surgical resection and radiosurgery with careful consideration.

• Journal of Chest Surgery
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• 제31권9호
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• pp.861-866
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• 1998

심실중격결손이 동반된 폐동맥폐쇄(PA/VSD)는 폐동맥의 형태 및 공급원이 매우 다양하고, 폐동맥의 발육부전 과 협착 및 폐동맥지 연결이상 유무가 교정수술시의 문제점으로 대두되고 있으므로, 저자들은 동맥관인접협 착(juxtaductal stenosis)이 동반되어 있는 환자들을 대상으로 체폐단락술전후 폐동맥 크기의 변화를 비교하 여, 수술방법 및 시기를 결정하는데 도움이 되고자 본 연구를 하였다. 1991년 7월부터 1996년 7월까지 연세대 학교 심장혈관센터에서 심실중격결손이 있는 폐동맥폐쇄환자중 동맥관인접협착이 동반되어 체폐단락술을 시행 한 59례가 있었으며, 수술전후의 심도자술 및 심혈관조영술을 시행한 29례를 대상으로 하였다. 우측(10례, Group I) 및 좌측단락술(19례, Group II)에서 단락술전후의 하행대동맥, 양측폐동맥 및 동맥관인접협착 부위의 직경을 측정하여, 수술부위에 따른 수술전후 변화를 비교하였다. 두 군에서, 하행대동맥직경에 대한 동측 폐동 맥직경의 비(ratio)가 수술전 0.78$\pm$0.31에서 수술후 1.01$\pm$0.26로, 또한 수술전 0.67$\pm$0.18에서 수술후 0.84$\pm$ 0.27로 각각 유의하게 증가하였으며, 편측 폐동맥직경의 비는 수술전 0.92$\pm$0.28에서 수술후 1.05$\pm$0.15로, 또한 수술전 0.94$\pm$0.27에서 수술후 1.08$\pm$0.37로 각각 증가하였으나 통계학적으로 유의하지는 않았다. 동맥관 인접협착 부위의 변화는 수술전 0.43$\pm$0.27에서 수술후 0.39$\pm$0.25로, 또한 수술전 0.32$\pm$0.10에서 수술후 0.30$\pm$0.16로 감소하는 경향을 보였으나 통계학적으로 유의하지 않았으며, 2례의 경우에서는 수술후 단절된 소견을 보였다. 체폐단락술을 통한 폐동맥혈류의 확보는 폐혈관 성장에 좋은 효과가 있으므로 폐혈류 감소 및 폐동맥 발육부전환자에서 추천되는 치료법이나 심실중격결손을 동반한 폐동맥폐쇄의 경우에는 동맥관인접협착의 변화가 중요한 것으로 생각된다. 본 연구 결과에서는 체폐단락술을 시행한 동측의 폐동맥이 성장함을 확인할 수 있었고, 동맥관인접협착은 악화될 가능성이 있는 것으로 생각되었다. 또한, 좌측 체폐단락술을 시행하여, 2례의 좌측 폐동맥의 단절을 경험하였다. 그러므로, 체폐단락술을 시행한 경우에는, 보다 철저한 술후 추적 및 검사가 요구되며, 동맥관인접협착이 동반된 측의 폐동맥에 단락술을 시행한 경우에는 조기에 완전 교정술을 고려하여야 할 것으로 사료된다.

• 대한두경부종양학회지
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• 제5권1호
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• pp.5-13
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• 1989

Carotid body paraganglioma is uncommon, with appoximately 900 reports of it in the world literature, and with only 7 documented cases in the Korean literature. The classic carotid body paraganglioma develops in the bifurcation of common carotid artery and involves both the internal and external carotid arteries at it expands. The diagnosis may almost always be established preoperatively by selective angiography which shows a widening of the carotid bifurcation with a well defined vascular mass. Differential consideration of a single, lateral cervical mass in this location include branchial cleft cyst, neurogenic tumor, metastatic thyroid cancer, carotid body aneurysm and salivary gland tumor. Surgical therapy is the preferred method of treatment as these tumors are regarded as radioresistant. Because of their high vascularity and anatomical location, surgical removal of these tumors reguires a considerable degree of caution and a high degree of surgical expertise. With improved diagnostic and surgical technique, the morbidity and mortality has been reduced lately. This report details the management of 3 patients with carotid body paraganglioma who underwent safe resection by subadventitial dissection or using an internal vascular shunt.

• Journal of Chest Surgery
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• 제17권3호
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• pp.484-487
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• 1984

A 12-yr-old patient was admitted due to severe hemoptysis and known cyanotic CHD. In chest P-A and echocardiogram, pulmonary aspergilloma in left upper lobe was associated with TOF. The cardiac catheterization couldnt be done because of frequent hypoxic spell and severe hemoptysis. Surgical management was performed. After left posterolateral thoractomy, modified Blalock-Taussig shunt operation and left upper lobe lobectomy were done at same time. Postoperative PaO2 was elevated and hemoptysis was disappeared.

• 한국임상수의학회지
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• 제29권6호
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• pp.488-493
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• 2012

두 마리의 말티즈견 (2살 중성화 암컷, 4개월 암컷)과 한 마리의 페키니즈견 (10살 수컷)이 구토, 식욕부진, 두위하강과 침흘림 등의 증상으로 내원하였다. 신체검사, 혈액검사, 방사선검사, 초음파, 컴퓨터단층촬영이 진단을 위해 실시되었다. 실험실 검사에서 높은 간수치, 담즙산 수치, 암모니아 농도가 세 마리 모두에서 확인되었다. 두 마리의 환축에서 방사선검사 상 소간증이 확인되었다.복부 초음파 검사에서 세 마리 모두 문맥전신 단락이 많이 의심되어 컴퓨터단층촬영을 실시하였고, 그 결과 모두 단일 간외성 문맥전신 단락으로 확인되었다. 진단 후 세마리는 모두 수술적인 방법을 통해 단락 혈관에 아메로이드 링을 적용하였다. 본 증례보고는 세 마리의 개에서 발생한 단일 간외성 문맥전신 단락 증례에 대한 임상적, 영상학적인 특징들을 잘 나타내고 있으며, 컴퓨터단층촬영이 문맥전신단락의 정확한 진단을 위해 유용한 진단기법임을 잘 나타내고 있다.

• Journal of Chest Surgery
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• 제19권2호
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• pp.335-340
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• 1986

Pulmonary arteriovenous fistula is unusually congenital malformation consisting of an abnormal connection between a pulmonary artery and vein. It may appear as an isolated anomaly or with hereditary hemorrhagic telangiectasis. In the classic form, symptoms and signs are caused by the abnormal right to left shunt. since severe clinical symptoms such as paradoxical embolism, infection, and spontaneous rupture with massive bleeding may occur, surgical treatment is often indicated. Recently we have experienced a surgical treatment of pulmonary arteriovenous fistula in 54 years old housewife. She was admitted in May 1986 with recurrent hemoptysis for 1 month. On admission, the PaO2 was 65.2 mmHg without specific findings. Pulmonary arteriovenous fistula was confirmed by preoperative pulmonary arteriography. A well circumscribed cystic mass was noted in visceral subpleural and inferior lingular segment of left upper lobe. Left upper lobectomy was performed with good results. Histologically angiomatous dilatation of abnormal vessels embedded in lung parenchyma was noted. Postoperative PaO2 was 90 mmHg. Postoperative results were good.

• Journal of Chest Surgery
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• 제17권2호
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• pp.197-204
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• 1984

The criss-cross, a term first used by Anderson and Ando , is a rare cardiac malformation in which the systemic and pulmonary blood streams cross at the atrioventricular level, without mixing. We have surgically experienced four cases of crossed atrioventricular connection, three concordant and one discordant, at Seoul National University Hospital from July 1982 to March 1984. The atrial situs, the atrioventriculoarterial connection, the spatial position of the ventricles, and associated cardiac anomalies were analyzed. We have performed right Blalock-Taussig shunt for case 1, modified Fontan operation for case 2, patch closure of VSD for case 3, and septation of common ventricle with primary closure of ASD for case 4. The relatively good postoperative results in these patients were gratifying and suggest that cardiac anomalies associated with this rare malformation can be successfully repaired without further risk. To our knowledge, this is the first report of surgical experience for criss-cross heart in the Korean literature.

• Journal of Chest Surgery
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• 제23권6호
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• pp.1280-1287
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• 1990

A seven month old female infant with isolated ventricular inversion and anatomically corrected malposition of the great arteries in situs solitus, associated with ventricular septal defect, patent ductus arteriosus, right-sided juxtaposition of left atrial appendage, is reported. The patient showed usual atrial arrangement with somewhat superoinferior relation, a discordant atrioventricular connection, and a concordant ventriculoarterial connection with aorta in the right-sided position. A normal sized left atrium was connected to the left superiorly positioned morphologic right ventricle through a tricuspid valve, which crossed the left ventricular outflow tract anteriorly. Well developed bilateral[subaortic and sub-pulmonary]conus was documented at operative field. successful surgical repair was done by performing the Senning procedure and by closing the ventricular sepal defect with a patch through the right ventriculotomy. The infant’s postoperative course was uneventful with normal sinus rhythm. Postoperative cardiac catheterization revealed no hemodynamic obstruction or residual shunt.

• Journal of Chest Surgery
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• 제24권7호
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• pp.719-724
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• 1991

A case of pulmonary atresia with intact ventricular septum was presented in a 10-month-old cyanotic female patient, which was congenitally rare. Infant with pulmonary atresia and intact ventricular septum usually require urgent surgical intervention. Angiogram showed the pulmonary atresia at the level of the pulmonary valve, the hypoplasia of tricuspid valve and atrial septal defect without patent ductus arteriosus. We performed the pericardial patch graft on the right ventricular outflow tract and pulmonary artery after ventriculotomy using pacemaker wire as electrical saw and main pulmonary arteriotomy and then modified Waterston shunt from the ascending aorta to patch on the right ventricular outflow tract without extracorporeal circulation. Patient was postoperatively good condition.

• Journal of Chest Surgery
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• 제46권6호
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• pp.433-438
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• 2013

Background: Surgical repair of post-infarct ventricular septal defect (VSD) is considered one of the most challenging procedures having high surgical mortality. This study aimed to evaluate the outcomes of the surgical repair of post-infarct VSD. Methods: From May 1991 to July 2012, 34 patients (mean age, $67.1{\pm}7.9$ years) underwent surgical repair of post-infarct VSD. A retrospective review of clinical and surgical data was performed. Results: VSD repair involved the infarct exclusion technique using a patch in all patients. For coronary revascularization, 12 patients (35.3%) underwent concomitant coronary artery bypass graft, 3 patients (8.8%) underwent preoperative percutaneous coronary intervention, and 9 patients (26.5%) underwent both of these procedures. The early mortality rate was 20.6%. Six patients (17.6%) required reoperation due to residual shunt or newly developed VSD. During follow-up (median, 4.8 years; range, 0 to 18.4 years), late death occurred in nine patients. Overall, the 5-year and 10-year survival rates were $54.4%{\pm}8.8%$ and $44.3%{\pm}8.9%$, respectively. According to a Cox regression analysis, preoperative cardiogenic shock (p=0.069) and prolonged cardiopulmonary bypass time (p=0.008) were independent predictors of mortality. Conclusion: The early surgical outcome of post-infarct VSD was acceptable considering the high-risk nature of the disease. The long-term outcome, however, was still dismal, necessitating comprehensive optimal management through close follow-up.